2. Most of viral infections tend to affect the
epithelium both of the conjunctiva and cornea;
thus the typical viral lesion is a
‘keratoconjunctivitis’
4. Adenoviral Conjunctivitis
• Adenoviruses are the commonest causes of viral conjunctivitis
• Non-enveloped, double stranded DNA viruses, which replicate within the
nucleus of host cells. General reservoir is only human.
Type of adenoviral conjunctivitis
• Epidemic keratoconjunctivitis (EKC)
• Nonspecific acute follicular conjunctivitis
• Pharyngoconjunctival fever (PCF)
• Chronic relapsing adenoviral conjunctivitis
5. 1. Epidemic Keratoconjunctivitis (KC)
• A type of acute follicular conjunctivitis mostly associated with superficial
punctate keratitis & usually occurs in epidemics, hence EKC.
• Caused by adenoviruses type 8 & 19. (it is markedly contagious)
• incubation period after infection (8 days) & virus shed from the inflamed eye for 2-3
weeks.
Symptoms
• Redness of sudden onset + watering, usually
profuse, with mild mucoid discharge
• Ocular discomfort & foreign body sensation.
• (mild) photophobia, become marked when
cornea is involved.
7. Treatment
I. Supportive treatment for amelioration of symptoms is the
only treatment required and includes:
• Cold compresses, and sun glasses to decrease glare,
• Decongestant and lubricant tear drops to decrease discomfort
II. Topical antibiotics; to prevent superadded bacterial infections
Prevention of spread of infection to the contacts
- Highly contagious and patients may be infectious for up to 11
days after onset
Transmission usually occurs
• From eyes to fingers to eyes
• Tonometers, contact lenses and eye drops
8. 2. Nonspecific Acute Follicular
Conjunctivitis
• Most common form of acute follicular conjunctivitis
• Caused by adenovirus serotypes 1 to 11 & 19
• Milder form of acute follicular conjunctivitis.
• Treatment similar as EKC
9. 3.Pharyngoconjunctival Fever (PCF)
• adenoviral infection commonly associated with subtypes 3 & 7.
• PCF primarily affect children & appears in epidemic form
• Treatment is similar as EKC
Clinical features
• Acute follicular conjunctivitis, associated
with pharyngitis.
• Fever & pre-auricular lymphadenopathy.
• Cornea : superficial punctate keratitis. (30%)
10. Acute Herpetic Conjunctivitis
• Always an accompaniment of the ‘primary herpetic infection’, mainly
occur in children and adolescents.
• Commonly caused by herpes simplex virus type 1 and spreads by kissing or
other close personal contacts.
• HSV type 2 associated with genital infections, may also involve the eyes
in adults as well as children, though rarely.
• Treatment
• Usually self limiting
• Topical antiviral drugs control the infection effectively and prevent
recurrences
• Supportive measures are similar with EKC
11. • Clinical features
• Usually unilateral affection
• May occur in 2 forms: typical and atypical
• Typical form: follicular conjunctivitis and other primary infection such as
vesicular lesions of face & lids
• Atypical form: follicular conjunctivitis without lesions of face, eyelid. The
condition resembles epidemic keratoconjunctivitis but may envolve through
phases of no-specific hyperaemia, follicular hyperplasia & pseudomembrane
formation
• Preauricular lymphadenopathy always occur
12. Acute Hemorrhagic Conjunctivitis
• Acute conjunctivitis
characterized by multiple
conjunctival haemorrhages,
conjunctival hyperaemia &
mild follicular hyperplasia.
• Caused by Picornaviruses
(enterovirus type 70)
• very contagious &
transmitted by direct hand-
to-eye contact
13. • Incubation period : 1-2 days
• Symptoms
• Pain
• Redness
• Watering
• Mild photophobia
• Transient blur of vision
• Lid swelling
• Signs
• Conjunctival congestion
• Chemosis
• Multiple hemorrhage in bulbar
conjunctiva
• Mild follicular hyperplasia
• Lid edema
• Pre-auricular lymphadenopathy
• Corneal sign : fine epithelial
keratitis
• Prophylactic measure similar to EKC.
• Broad-spectrum antibiotic eyedrop.
• Usually the disease has a self-limiting
course of 7 days.
• Supportive measure same as EKC.
Treatment
14. Ophthalmia Neonatorum
• Bilateral inflammation of the conjunctiva occurring in infant
• Usually as a result of carelessness at the time of birth
• Any discharge or even watering from the eyes in the first week of
life should arouse suspicion of ophthalmia neonatorum, as tears
are not formed till then
• Causative agents
• Gonococcal infection
• Other bacterial infections
• Staphylococcus aurues,
Streptococcus haemolyticus, and
Streptococcus pneumoniae
• Neonatal inclusion conjunctivitis
• Serotypes D to K of Chlamydia
trachomatis
• Herpes simplex-II virus
15. Clinical features
• Pain and tenderness in the eyeball
• Conjunctival discharge
o Purulent in gonococcal
o Mucoid or mucopurulent in other bacterial cases and
neonatal inclusion conjunctivitis
o Lids are usually swollen
o Eyelids and periocular vesicles may occur in HSV
infection
o Conjunctiva may show hyperaemia and chemosis
16. Treatment
• Prophylaxis needs antenatal, natal and postnatal care.
o Use either 1% tetracycline ointment or 0.5% erythromycin ointment into the eyes of babies
immediately after birth are useful for preventing bacterial and chlamydial ophthalmia
neonatorum.
• Curative treatment
Causative agents Treatment
Gonococcal Needs prompt treatment to prevent complications
1. Topical therapy
• Saline lavage hourly till discharge is eliminated
• Bacitracin eye ointment 4 times/day
• If cornea is involved, atropine sulphate ointment can be applied.
2. Systemic therapy
• Ceftriaxone, cefotaxime, ciprofloxacin
Other bacterial Treat with broad-spectrum antibiotics drops and ointment for 2 weeks
• Neomycin-bacitracin, tobramycin
Neonatal inclusion
conjunctivitis
Topical 1% tetracycline ointment or 0.5% erythromycin ointment qid for 3 weeks
Systemic erythromycin (125 mg orally, qid for 3 weeks); presence of chlamydia agents in the
conjunctiva implies colonization of URT as well.
Herpes simplex Self-limiting
However, antiviral drugs may control the infections and prevent the recurrence.
Editor's Notes
Superficial punctate keratitis is death of small groups of cells on the surface of the cornea
Chemosis is the swelling (or edema) of the conjunctiva. It is due to exudation from abnormally permeable capillaries.
